Internal Medicine

P1: SBT

0521779407-05 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:49

Atrioventricular Block Autoimmune Hepatitis (AIH) 201

■Asymptomatic Type II second-degree AV block with narrow QRS

(Class IIa)

■Asymptomatic Type I AV block with EP documented intra- or infra-

Hisian block (Class IIa)

Third-degree AV block:

■Symptomatic bradycardia (Class I)

■Asymptomatic patients: asystole >3 sec or escape rate <40 bpm while

awake, especially if LV dysfunction is present (Class I)

■AV block from neuromuscular diseases (Class I)

■Asymptomatic patients with rate >40 bpm while awake (Class IIa)

Side Effects & Contraindications

■None

follow-up

■ECG and Holter monitoring if symptoms appear. Pacemaker follow-

up after implantation.

complications and prognosis

■Pacemaker: cardiac perforation; lead dislodgement; infected pace-

maker pocket; lead fracture; failure to sense; failure to pace; pulse

generator depletion. Requires specialized pacemaker follow-up.

Autoimmune Hepatitis (AIH)............................

ANDY S. YU, MD and JOANNE C. IMPERIAL, MD

history & physical

History

■Disease of young (age 15–35) & perimenopausal women

■Classified into types 1, 2, 3

■Strong relationship w/ HLA A1-B8-DR3, DR4

■Often associated w/ extrahepatic immunologic diseases: thyroiditis,

vasculitis, Coombs-positive hemolytic anemia, uveitis, connective

tissue disorders

■Must exclude other liver diseases in order to confirm diagnosis (hep-

atitis B & C, excessive alcohol use, hepatotoxic medications, biliary

tract disease)

Signs & Symptoms

■Fatigue (85%) & jaundice (50%) common